Feature Story

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Self-management program helps people with chronic diseases improve their health status and avoid hospitalization

People 60 years of age and older are estimated on average to have two or more chronic health conditions such as arthritis, stroke, lung disease, or heart disease. These conditions typically require the patient to maintain a certain diet, exercise, and adhere to a medication regimen to improve their health, which ideally they self-manage with a doctor's guidance. Traditional patient-education or self-management programs have focused on a specific disease such as diabetes or asthma. However, this study found that a self-management program can educate a group of patients with different chronic diseases; it can improve their health behaviors and health status and reduce hospitalizations and days in the hospital.

The Chronic Disease Self-Management Program (CDSMP) was developed by researchers at Stanford University Kaiser Permanente, Northern California Region, and the University of California, San Francisco. Their work was supported in part by the Agency for Health Care Policy and Research (HS06680). The researchers trained lay instructors, who themselves had chronic diseases, to educate 952 adults with heart disease, lung disease, stroke, or arthritis in disease self-management. The groups were made up of 10 to 15 people of mixed ages and diagnoses and met at a community site in seven weekly 2.5-hour sessions. At each site, participants were randomized to the CDSMP or usual treatment (controls); participants' physicians were not informed as to their study status.

Rather than prescribing specific behavior changes, the CDSMP leaders helped participants make management choices and reach self-selected dietary, exercise, and medication goals. Participants also helped each other solve disease-related problems and discussed how to manage symptoms such as pain or fatigue. Compared with controls, the CDSMP group significantly increased their number of minutes per week of stretching/strengthening and aerobic exercise; increased practice of cognitive symptom management; improved communication with their physician; significantly improved their overall health status; and had fewer hospitalizations. Overall savings in health care costs were about $750 per participant, more than 10 times the cost of the program ($70 per participant).

Of the 391 control subjects who completed the 6-month randomized study, 283 (72 percent) chose to take the CDSMP. Of these, 237 provided 6-month endpoint data. This group increased their aerobic exercise and use of coping strategies, and they decreased their disability and health distress while increasing social and role activities. Visits to physicians decreased, and they had fewer visits to hospitals and fewer days in the hospital. By taking the CDSMP, the control subjects reversed many of the trends toward worsening health demonstrated during the previous 6-month randomized trial, note the researchers.